Equine dental disease part 4: a long-term study of 400 cases: apical infections of cheek teeth.

Authors: Dixon P M, Tremaine W H, Pickles K, Kuhns L, Hawe C, McCann J, McGorum B C, Railton D I, Brammer S

Journal: Equine veterinary journal

DOI: 10.2746/042516400776563581 PubMed: 10836472Log in to save

Summary

# Editorial Summary: Apical Infections in Equine Cheek Teeth Among 400 horses presenting with dental disease, Dixon and colleagues identified apical infections as the primary pathology in 162 cases, with a notably different clinical presentation depending on tooth location and jaw position. Rostral maxillary cheek teeth infections manifested predominantly as local swelling (82%) and sinus tracts (26%), whilst caudal maxillary infections were characterised by nasal discharge in 95% of cases despite less visible facial swelling; mandibular apical infections commonly presented with swelling (91%) and drainage tracts (59%), frequently associated with tooth eruption. Treatment outcomes varied significantly by location: caudal maxillary infections complicated by secondary sinusitis proved most resistant, with only 33% achieving complete resolution following initial intervention, whereas oral extraction consistently outperformed alternative approaches (medical treatment, curettage, repulsion) across all tooth positions and demonstrated good long-term prognosis in the majority of cases. These findings suggest that clinicians should anticipate location-specific clinical signs when investigating suspected apical infections, reserve particular caution when secondary sinusitis accompanies caudal maxillary tooth disease, and consider oral extraction as the preferred treatment modality for optimal outcomes rather than pursuing more conservative or extractive alternatives.

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Practical Takeaways

•Clinical presentation of equine apical infections varies by location: expect facial swelling with rostral maxillary lesions but nasal discharge with caudal maxillary lesions
•Oral extraction offers superior long-term outcomes compared to medical treatment, apical curettage, or repulsion in most cases
•Caudal maxillary apical infections complicated by sinusitis are challenging to treat and warrant aggressive early intervention or referral

Key Findings

•Of 400 horses with dental disease, 162 (40.5%) had primary apical infections of cheek teeth: 92 maxillary and 70 mandibular
•Rostral maxillary infections presented with swelling (82%) and sinus tracts (26%), while caudal maxillary infections showed nasal discharge (95%) and were associated with secondary sinusitis
•Mandibular apical infections commonly presented with mandibular swelling (91%) and sinus tracts (59%), closely related to tooth eruption
•Oral extraction was the most successful treatment; caudal maxillary infections with sinusitis were most refractory with only 33% complete response to initial treatment

Conditions Studied

apical infections of cheek teethmaxillary cheek tooth infectionsmandibular cheek tooth infectionsparanasal sinusitisdental disease

Related References

Radiographic, computed tomographic, gross pathological and histological findings with suspected apical infection in 32 equine maxillary cheek teeth (2012-2015).

Liuti T, Smith S, Dixon P M(2018)Equine veterinary journal

Standing oral extraction of cheek teeth in 100 horses (1998--2003).

Dixon P M, Dacre I, Dacre K, Tremaine W H, McCann J, Barakzai S(2005)Equine veterinary journal

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Bühler M, Fürst A, Lewis F I, Kummer M, Ohlerth S(2014)Equine veterinary journal

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Dixon P M, Savill D, Horbyl A, Reardon R J M, Liuti T(2014)Veterinary journal (London, England : 1997)